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Attenuated Psychosis Syndrome
DSM-5 Proposed Criteria A'''. At least one of the following symptoms is present in attenuated form, with relatively intact reality testing, and is of sufficient severity or frequency to warrant clinical attention: # Delusions. # Hallucinations. # Disorganized speech. '''B. Symptom(s) must have been present at least once per week for the past month. C'''. Symptom(s) must have begun or worsened in the past year. '''D. Symptom(s) is sufficiently distressing and disabling to the individual to warrant clinical attention. E'''. Symptom(s) is not better explained by another mental disorder, including a depressive or bipolar disorder with psychotic features, and is not attributable to the physiological effects of a substance or another medical condition. '''F. Criteria for any psychotic disorder have never been met. Differential Diagnosis Brief psychotic disorder When symptoms of attenuated psychosis syndrome initially manifest, they may resemble symptoms of brief psychotic disorder. However, in attenuated psychosis syndrome, the symptoms do not cross the psychosis threshold and reality testing/insight remains intact. Schizotypal personality disorder Schizotypal personality disorder, although having symptomatic features that are similar to those attenuated psychosis syndrome, is a relatively stable trait disorder not meeting the state-dependent aspects (Criterion C) of attenuated psychosis syndrome. In addition, a broader array of symptoms is required for schizotypal personality disorder, although in the early stages of presentation it may resemble attenuated psychosis syndrome. Depressive or bipolar disorder Reality distortions that are temporally limited to an episode of a major depressive disorder or bipolar disorder and are descriptively more characteristic of those disorders do not meet Criterion E for attenuated psychosis syndrome. For example, feelings of low self-esteem or attributions of low regard from others in the context of major depressive disorder would not qualify for comorbid attenuated psychosis syndrome. Anxiety disorders Reality distortions that are temporally limited to an episode of an anxiety disorder and are descriptively more characteristic of an anxiety disorder do not meet Criterion E for attenuated psychosis syndrome. For example, a feeling of being the focus of undesired attention in the context of social anxiety disorder would not qualify for comorbid attenuated psychosis syndrome. Bipolar II disorder Reality distortions that are temporally limited to an episode of mania or hypomania and are descriptively more characteristic of bipolar disorder do not meet Criterion E for attenuated psychosis syndrome. For example, inflated self-esteem in the context of pressured speech and reduced need for sleep would not qualify for comorbid attenuated psychosis syndrome. Borderline personality disorder Reality distortions that are concomitant with borderline personality disorder and are descriptively more characteristic of it do not meet Criterion E for attenuated psychosis syndrome. For example, a sense of being unable to experience feelings in the context of an intense fear of real or imagined abandonment and recurrent self-mutilation would not qualify for comorbid attenuated psychosis syndrome. Adjustment reaction of adolescence Mild, transient symptoms typical of normal development and consistent with the degree of stress experienced do not qualify for attenuated psychosis syndrome. Extreme end of perceptual aberration and magical thinking in the non-ill population This diagnostic possibility should be strongly entertained when reality distortions are not associated with distress and functional impairment and need for care. Substance/medication-induced psychotic disorder Substance use is common among individuals whose symptoms meet attenuated psychosis syndrome criteria. When otherwise qualifying characteristic symptoms are strongly temporally related to substance use episodes, Criterion E for attenuated psychosis syndrome may not be met, and a diagnosis of substance/medication-induced psychotic disorder may be preferred. Attention-deficit/hyperactivity disorder A history of attentional impairment does not exclude a current attenuated psychosis syndrome diagnosis. Earlier attentional impairment may be a prodromal condition or comorbid attention-deficit/hyperactivity disorder.